Ablation of atrial insertion sites of left-sided accessory pathways in children: efficacy and safety of transseptal versus transaortic approach

• Published in: Pediatric cardiology 1997-09, Vol.18 (5), p.332-338
• Main Authors: Vora, A M, McMahon, S, Jazayeri, M R, Dhala, A
• Format: Article
• Language: English
• Subjects: Adolescent; Cardiac Catheterization; Cardiac Pacing, Artificial; Case-Control Studies; Catheter Ablation - methods; Child; Child, Preschool; Echocardiography; Female; Heart Conduction System - physiopathology; Humans; Male; Retrospective Studies; Tachycardia, Supraventricular - diagnosis; Tachycardia, Supraventricular - physiopathology; Tachycardia, Supraventricular - surgery
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s002469900194

Left-sided accessory pathways are a common substrate for supraventricular tachycardias in children. A transseptal approach to catheter ablation has been primarily advocated in this population because of concerns regarding vascular injury, aortic, and mitral valvular damage using the transaortic approach via retrograde femoral arterial cannulation. However, the transaortic approach is simpler and may be less time consuming. We, therefore, compared the efficacy and safety of the transseptal vs the transaortic approach in 49 consecutive pediatric patients. In both groups, the atrial insertion site of the accessory pathways was targeted. Postprocedure two-dimensional and Doppler echocardiograms were obtained in all patients. The transseptal and transaortic groups were similar in age (15.8 +/- 1.6 vs 13.5 +/- 3.6 p NS), manifest vs concealed (9/5 vs 20/15), and number of radiofrequency lesions (4 vs 6). Fluoroscopy time was significantly shorter in the transaortic group (33 vs 58 min, p < 0.05). The only evident complications were mild mitral regurgitation seen in two patients (one in each group). Two patients in the transseptal group had recurrence of tachycardia on follow-up and were successfully ablated by the transaortic method. In this series from a single center, a transaortic approach to ablation of left-sided accessory pathways in children older than 4 years was as effective as a transseptal approach.